Rosie and Me: Day 16. A Hop, Scrip, and My Rump

It was a travel day, sports fans, but not before having a lovely early morning breakfast with my daughter and son-in-law after he got off his all nighter in the ED. He only saw two patients last night, so it was reallllllly slow. Bad for training.

We went to a place call Snooze in downtown Denver and it was a blast. Of cold air. Outside. As the sun was coming up. Sheesh.

After we ate we strolled round the interior of the building, commenting about how nice and open it was and how it looked a lot like Grand Central in NYC and on and on. Early mornings are not good for keen observations and paying attention to detail, so it struck me as funny when I got in my car and drove past the building out of town, seeing the huge words UNION STATION emblazoned in the stone edifice out front.

Before I left, I did stop in at the Tattered Cover bookstore, as a friend of mine had told me to be on the lookout for it and asked if I had seen it yet. Well, now I can say yes! There is still something about an old fashioned indie bookstore that carries a little bit of everything for every person and every taste. I still am a sucker for bookstores, and I got out of the place with a little less than a hundred dollars’ worth of damage, but I can justify it by saying that I bought a gift for someone else.

There is still a wonderful feeling when you hold a book, new or old, paper or hardback, in your hands, leafing through the pages, smelling the paper, and anticipating how nice it would be to lie in bed with the covers up over your legs and said book propped on your chest, ready to pretend to read for those ten minutes it will take you to fall asleep. I have often kidded myself that I would read more when I had an iPad or a Kindle, but that has not proven true. I’m still more likely to start and finish a book that is the real paper and spine kind.

I left Denver, marveling at the majestic snow-covered peaks of the Rockies as long as I could physically see them in my rearview mirror, then turned Rosie towards the high plains of Kansas. It is wide open spaces and flatness out there, ladies and gents. Miles and miles of straight road.

I noticed that there began to pop up more and more windmill farms of the sort that I drove by in Indiana two weeks ago. One of these went for miles, with hundreds of turning white windmills. I also noticed fields of plants, green with dark brown tops, on both sides of the road, acres and acres of them. Hops, I thought, since we had had our introduction to brewing and hops and yeast and oak chips yesterday at the Great Divide Brewery.

I later figured out that these were most likely not hops, but acres and acres of sorghum plants. This is a very interesting crop that has been called the “camel of crops” and is very useful in dry, hot conditions.

When I got to my destination for today, Salina, Kansas, I got off the interstate and was turning left off of I-135. To my left at the red light, as in so many other cities in so many other states on this trip, I saw a homeless man leaned up against a sign post. He was wearing dirty khakis, a jacket, a hat and shades over his eyes. He was leaned back against the pole, not moving an inch, not even putting forth the effort to hold up his sign (remember the man I wrote about in Spokane the other day?), which said, quite simply: “Money, please.”

At least one of you (and you know who you are) has been concerned about the state of my posterior over such a long trip as this, and how I combat the Derrière Doldrums over thousands of miles of driving. Well, all I can say is that getting to the gym regularly and then being taken on very long walks and hikes and doing urban hikes (like yesterday’s) on my own have all helped to combat Butt Burnout. Rosie’s leather seats are nicely broken in now, the supports are good, and the frequent stops and daily exercise are helping tremendously. Thanks for your concern for my coccyx. It is greatly appreciated.

Tomorrow will be another busy day, with a trip to the Eisenhower Museum and Library in the morning, and then a side trip to the Wyldewood Cellars afterwards to pick up some elderberry wine products. After that, it’s on to Kansas City for the night, and perhaps either some excellent barbecue or perhaps a Winstead burger and a large chocolate malt. Decisions, decisions.

I hope you have all had good days, and I appreciate every one of you who takes the time to stop by and read my observations about the world. That’s a big part of why I keep writing. it’s fun for me, and I hope it’s fun for you too.

Good night, dear readers, from Salina, Kansas.

Buddy, Can You Spare a Dime?


Okay, so this morning I want you to think about something with me. I want you to be honest, as honest as you can, as I will be with you too. Deal? We can’t move forward until you agree.


What do you feel when you’re driving along, you come to the next busy intersection, stop for the red light, and see that homeless guy? You know the very one I’m talking about. That homeless guy with his grimy, almost blackened clothes, week’s growth of beard, and the cardboard sign that says Will work for food or some such?

Nope, nope, nope, come back here. You said you would be honest with me, and I’m not going to let you weasel out of this one that easily. Your second cup of coffee can wait.

You don’t know this man. You don’t know his story. You don’t know if he’s a scammer (you really think that likely he is), a deadbeat dad (how could he not be, you think, dressed like that and begging?), or just a really, really lazy person (Of course he is-I work for food every day. It’s called a job!). Do you look at him critically, looking for clues to his story in that brief minute that the light is red? Do you look on him with compassion, feeling a sense of urgency to help? Do you look at him with a sense of guilt, knowing that if you don’t help him, right now, that nobody else is likely to for the rest of this day?

Now, take that feeling that you had at the red light, or those feelings, because my hunch is of you’re like me you had a smattering of all of them, and sit with them a minute. How do they hit you? Do they make you feel empowered? Sad? Angry at society? Helpless? Energetic? Depressed. Full of empathy? Disengaged?

Take those feelings and multiply them by a hundred, a thousand, ten thousand. Doesn’t feel so good, does it? Feels downright bad. You want to stop feeling that way. You want to get back to feeling good again, driving away from that intersection and going shopping and spending your money and hugging your children and smelling the fabric softener in your clean clothes.

Indigent patients, truly indigent patients, hit us like that in the emergency department hundreds or thousand of times each month. They are the truly poor, the truly needy. The ones who will be with us always, no matter the party in power or the stock market close. Homeless, down on their luck, no job, no money, no place to stay. Using drugs. Coming in with blood alcohol levels of three, four hundred. Dirty. Smelly. Reeking of alcohol and sweat and vomit and street grime.

I’m sorry, but my part of this bargain is to be honest with you since you stuck around with me.

We all know that being a doctor is glamorous, right? It’s all about Patch Adams and House and ER and Marcus Welby and Grey’s Anatomy. It’s about quickie sex in the supply closet between exciting traumas. It’s about magic tricks and starched white coats and throwing your weight around because you’re a star surgeon who saves lives. It’s about sterile environments and bright lights and making that once in a lifetime diagnosis that gets you noticed and makes you a hospital legend.

Come on. You know better.

ED medicine is about grueling hours and long shifts and inexhaustible waiting rooms full of patients with chest pain and bleeding and suicide attempts and drug overdoses. It’s brutal, folks. A lot of the time it’s just brutal. I hate to burst your bubble, but there it is.

Indigent patients are one of those special groups I was telling you about the other day.

I got to the office yesterday and saw that there had been about a dozen psychiatric consults remaining to be seen when my colleague had gone off shift at midnight the night before. From midnight until eight AM the next morning, another thirteen or so had *dinged* into the work queue. Twenty-five patients with their own stories. A good number of them that guy. The one holding the sign at the intersection, or someone a lot like him.

How can we show compassion to the old, tired, smelly guy with the sign when we are tired before we even get started with the day’s shift? When we see the never-ending line of misery staring back at us on the computer screen and we just want to hit the gas and burn rubber and drive off?

I’ll tell you how.

First, we don’t go into this line of work unless we really want to help people. Sounds all rose colored glasses and kittens and sparkles and unicorns, but it must be true. It has to be. You don’t put up with this shit unless you want to be a doctor.

We train and train hard for a reason. We learn our craft and how to do it backwards, forwards, upside down and sideways, blindfolded and with one hand tied behind our backs. We take long hours of call, we work days on end with little rest and we see patients back to back to back so that we develop toughness. When the fifth indigent patient comes in with the same-old same-old story at midnight on a Saturday when we are so bone-tired that we can’t see straight, we give him the same ear and the same critical workup we’d give the lady with full insurance coverage who drove herself to the ED in the Lexus to have her arthritis checked out. If we’re good doctors we do, that is.

We care for each patient as a person, a person with worth. I don’t care if you’re down on your luck, if you have no money, if you have no job, and if you curse me for everything I’m worth as I tell you I’m going to commit you for your own safety after you drunkenly sliced your wrists opened and guzzled a mixed drink of Tylenol and scotch. I’m going to take care of you the way my excellent mentors taught me to, the same way I would want my own mother or daughters to be taken care of.

Being indigent is not a crime.

Being an arrogant, thoughtless, cold, uncaring doctor should be.